rania saeed l12 case presentation

ALJOHARA ALFAQEEH 42820042 1

Prepared by:Aljohara Alfaqeeh

ID #:42820042

Level:12

COMPREHENSIVE CASE PRESENTATION

RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY



Personal Data:

Age: 33 years old.

Gender: Female.

Nationality: Sudanese.

Occupation: Housewife.

Social Status: Married.

Patient’s Cooperation: Cooperative.

File Number : 42538.



Chief Complain:

“ Do a general check up because I have a lot of decayed & corroded teeth. ”

في “ متآكلة وحشوات تسوس لوجود نظرا األسنان على عام إجراءكشفاألسنان ”.بعض



Medical History:

She is medically fit.

She takes OCP pills for birth control.



Family Medical History:

There is no significant family medical history mentioned.



Past Dental History:

Multiple root canal treated teeth.

Multiple restored teeth.

Multiple extracted teeth.

1 FPD unit.



Oral Hygiene Activity:

-Good Oral Hygiene. - Patient uses:

Tooth brush : once & sometimes twice/day. Tooth Brush : soft brush. Brushing technique : horizontal (scrub) technique. Dental floss/ Meswak / Mouth wash : none.



Recommended:- Tooth brush type: Soft Nylon bristle tooth brush.

- Brushing Frequency: 2-3 times per day.

- Brushing Methods: modified bass technique.

- Interdental Aids: Dental floss.



Clinical Examination



I. Extra Oral Examination:

Skin TMJ Lymph nodes (Cervical, Submandibular) Neck

All within normallimits.



II. Intra Oral Examination (soft tissue):

Lips.Vestibules.Soft palate .Tongue .Floor of the mouth.

Hard Palate Patient has torus palatinus.

All within normallimits.



II. Intra Oral Examination (dentition):

Maxillary arch



II. Intra Oral Examination (dentition):

Mandibular arch



Pretreatment Photographs



Periodontal Chart



Gingival Index By: “Silness and Loe,1967”

Total = 1.1 Moderate gingival inflammation of the gingiva

11

11

11

12

11

11

11

11 2

11

1



Plaque Index: By: “Silness and Loe,1967”

Total = 0.75 Mild plaque accumolation

22

12

11

12

00

10

01

11

11 0

0



Calculus Score:Initial generalized calculus deposits.



3

3

333

13

PSR (Periodontal Screening & Recording):


Bleeding

M-CEJ

323 323 212 224 212 212 212 123 332 532 113 M-PD

CAL

28 27 26 25 24 23 22 21 11 12 13 14 15 16 17 18

28 27 26 25 24 23 22 21 11 12 13 14 15 16 17 18M-CEJ

121 322 221 212 222 212 212 223 222 545 344 M-PD

CAL

Bleeding


Bleeding

M-CEJ

422 324 433 323 112 211 212 212 211 311 312 212 222 345 M-PD

CAL

38 37 36 35 34 33 32 31 41 42 43 44 45 46 47 48

38 37 36 35 34 33 32 31 41 42 43 44 45 46 47 48M-CEJ

315 314 215 114 313 113 114 212 313 213 212 322 222 433 M-PD

CAL

Bleeding



Mobility assessment

0 No detectable mobility other than physiologic.

No Furcation involvement.

Local factors:

Plaque.

Calculus.

Iatrogenic factors : defective bridge and restorations.



Diagnosis:

Generalized mild Chronic Periodontitis.

Overall Prognosis:

Good.



Diet analysis:

- 3 meals/day.- Snacks between meals.- High sugar amount added to tea.- A lot of coffee and dates.



Recommendations:

- Reduction of Carbohydrates intake.- Reduce the amount of coffee and tea.- Include fruits and vegetables in her diet.



CRT (Caries Risk Test):

Saliva buffer capacity High Saliva viscosity Viscous



CRT (Caries Risk Test):

Mutans Streptococci : High RiskLactobacilli : High Risk

According to the “ Standard chart”



Salivary Flow Rate:

STIMULATED SALIVARY FLOW RATE :

1.2ml / min

NORMAL VALUES:

STIMULATED 0.7-1.5 ml/min.



Diagnostic tools:

Radiographs.

Mounted Cast.



Right Bitewings



Left Bitewings



Right Side Periapicals



Left Side Periapicals



Upper & Lower Anteriors Periapicals



• Mounted Diagnostic Cast

-Midline: Upper midline is normalLower midline deviated to the Right side by 2 mm. Mild Diastima frenectomy.-Vertical Overbite: 60% -Horizontal Over jet: 3 - 4mm

Anterior Cross bite.Lingual Cross bite.




Canine Relationship:Class I.

Molar Relationship:Non applicable.




Canine Relationship:Class I.

Molar Relationship:Non applicable.

Over eruption of the canine due the Lingual Cross bite.




No crowding.

Mild spacing.

Upper molars are rotated ( #18, #17, #27, #28).



Vitality & Percussion Test



Tooth # Cold test V. Percussion test

H. Percussion test

Pulp Diagnosis

Periapical Diagnosis

#17 +ve -ve -ve Normal Normal

Application of Endo Frost (-50° C) on suspected teeth.




H. Percussion test

Pulp Diagnosis


#14 -ve +ve -ve Previously Treated

SymptomaticApical Periodontitis





H. Percussion test

Pulp Diagnosis


#12 -ve -ve -ve Previously Treated

Normal





H. Percussion test

Pulp Diagnosis



Normal





H. Percussion test

Pulp Diagnosis







H. Percussion test

Pulp Diagnosis


#45 +++ve -ve -ve Irriversable Pulpitis (symptomatic)

Normal





H. Percussion test

Pulp Diagnosis


#46 -ve +ve -ve PreviouslyTreated

AsymptomaticApical Periodontitis




TREATMENT OBJECTIVES:

- CONTROL ACTIVE DISEASES.- EXTRACT NON RESTORABLE TEETH.- IMPROVE ORAL HYGIENE.- CARIES CONTROL.- RESTORE FUNCTION AND ESTHETICS.- MAINTAIN THE RESULTS.



Treatment Plan



Treatment Phases:Phase I : Emergency/ Preventive Treatment. Phase II : Operative Treatment.Phase III : Endodontic Treatment.Phase IV : Pre-Prosthetic / Surgical Treatment. Phase V : Prosthodontic Treatment.Phase VI : Recall & Maintenance.



Problem Proposed treatment

Generalized mild Chronic Periodontitis. Extraction of Hopeless teeth. OHI instructions & plaque control. Supragingival scaling & polishing. Correction of iatrogenic factor. Re-evaluation after 4 – 6 weeks. Maintenance every 3 months.



Tooth Proposed treatment

#18 Occlusal Caires Class I Composite restoration.




#17 Under prepared abutment.

Prepare the tooth for surveyed crown.




#16, #15 Missing. Implant.RPD.




#14 Extensive Caries. Extraction.




#12 Substandard RCT. + Root Resorption because of the trauma from occlusion (cross bite).

Remove Gp block the wall with MTA and wait till the internal wall of the tooth regenerate. After that RCT + post & core + Crown.

Or Extract the tooth and replace it

by :Implant PFM RPD




#11 Broken incisors + malformed restoration + Substandard RCT + Root Resorption.

Remove screw post + Redo RCT + post & core + porcelain crown.




#21 Broken incisors + malformed restoration.

Remove pin + Redo RCT + post & core + porcelain crown.




#22 Recurrent caries. Redo Class III composite restoration.




#23 Distal Caries Class III composite restoration.




#24 #25 #26 Missing. Implant.RPD.




#27 Faulty Restoration. Redo Restoration.




#28 Occlusal Caries. Class I Composite restoration.




#37 Faulty Restoration + recurrent caries.

Redo Restoration.




#36 Over hanged amalgam restoration.

Redo Restoration.




#42 #43 Over Eruption. Shave the teeth to create more space for the upper #12 & to relief the trauma from occlusion.




#34 Distal pit Caries. PRR.




#44 Pit Caries. PRR.




#45 Extensive Caries. Endo + Post and core & Crown ( tooth will need crown lengthening ).




#46 Extensive Caries. Extraction.




#47 Missing. Implant.RPD.




#48 Occlusal Caries. Class I Composite restoration.



Torus Palatinus:Treatment: Surgically remove the torus palatinus because if it will interfere with the placement of the denture and replace it with skin graft.

But in our case we wont remove it because our major connector is horse shoe.

Pre- Prosthetic/ Surgical Phase IV:



Prosthetic Phase V:



Wax Up



Prosthodontic Treatment:

RPD Design for Upper Arch

Major Connector

Direct Retainers

Indirect Retainers

Class III modification I

Horse Shoe #17 Surveyed Crown#17 #27 Aker Clasp#13, #23 T bar.

#13, #23 Cingulum Rest#17, #27 Mesial Rest



Prosthodontic Treatment:

RPD Design for Lower Arch

Major Connector

Direct Retainers

Indirect Retainers

Class III Lingual Bar #45 Surveyed Crown#45, #48 Aker Clasp#37, #36 Double Aker Clasp

#45, #36 Distal Rest.#48, #37 Mesial Rest.#33, #43 Cingulum Rest.



Recall & Maintenance Phase VI:

Recall Patient every 3 months :

For periodontal maintenance .

Recall Patient every 6 months :

To take full mouth radiographs and to check the restorations , prosthesis and RCT .



Treatment Phases:Phase I : Emergency/ Preventive Treatment. Phase II : Operative Treatment.Phase III : Endodontic Treatment.Phase IV : Pre-Prosthetic / Surgical Treatment. Phase V : Prosthodontic Treatment.Phase VI : Recall & Maintenance.



THANK YOU

rania saeed l12 case presentation

Travel

calbleeding alfaqeeh

neckaljohara alfaqeeh

gingivaaljohara alfaqeeh

aljohara alfaqeehid

soft brush

tooth brush type

brushing technique

soft nylon bristle tooth